Study links service in Middle East with lung disorder

7/21/2011 - A Vanderbilt study of U.S. soldiers returning from the wars in Iraq and Afghanistan with severe respiratory issues — likely due to prolonged exposures to sulfur fires and burn pits — was published Thursday in the New England Journal of Medicine (NEJM).

Robert Miller, M.D., associate professor of Pulmonary and Critical Care Medicine at Vanderbilt and his former colleague, Matt King, M.D., now assistant professor of Pulmonary and Critical Care at Meharry Medical College, compiled a descriptive series of 38 cases of constrictive bronchiolitis in soldiers since 2005.

The authors say they hope the article will add to a national push to examine respiratory complaints in returning veterans from the wars in Iraq and Afghanistan.

“It has been a long journey on many fronts, but I think this publication confirms this pulmonary disease is associated with service in the Middle East,” Miller said.

“You can look at a biopsy under a microscope and identify the issue, and we’re getting confirmation from around the country that we’re not the only ones seeing it.”

Of 49 soldiers who underwent surgical lung biopsy at Vanderbilt, 38 were shown to have a rare disease called constrictive bronchiolitis, which causes permanent shortness of breath during exercise.

Miller and King say the article should serve to alert other physicians to this aspect of respiratory illness in this population.

“This condition is not limited to this population but may be the largest series of constrictive bronchiolitis in previously healthy people; bigger than the population in the popcorn plant investigation,” Miller said.

That case, which was the subject of media attention and a NEJM article in 2002, was based on the surgical diagnoses of constrictive bronchiolitis in eight popcorn plant workers. Ultimately it was determined chemicals involved in producing microwave popcorn posed a health hazard, and safety measures were enacted to prevent harm to more workers.

But King and Miller each say protecting soldiers is more difficult. There is no single source to target as a cause of this lung disease.

“It’s a tough group to study. They move, it’s hard to get follow up. This is not like mice in a lab; soldiers are all over the world,” King said.

King was recently asked by the American Thoracic Society to testify before the U.S. Senate Subcommittee on Defense Appropriations about the need to dedicate more federal funding for testing of soldiers. He says publication in a major journal is a key to promoting action.

“I think we have had a major role in this national discussion. Dr. Miller is relentless. He never gave up and found collaborators to get more exposure to these problems. This article and others are compelling evidence that respiratory illness is specifically linked to land deployment and length of deployment and probably some form of toxic inhalation,” King said.

Miller says he and his colleagues at Vanderbilt continue to use the work documented in the article to press on with the science. They are shipping 45 slides to National Jewish Hospital in Denver, where a collaborator has just received a Department of Defense grant to try to determine what substances are lodged in the tissues of the lung samples.

“We want to characterize a dark pigment that appears in many of these the biopsies.

“We understand the researchers at National Jewish will work in conjunction with the U.S. Geologic survey to perform tests that will hopefully tell us about what the soldiers were exposed to,” Miller said.